凝血功能变化对老年AECOPD患者疾病严重程度的相关性及预测价值研究

Study of predictive value and correlation between the change of blood coagulation function and the severity of AECOPD in elderly patients

目的观察凝血功能指标水平变化与老年AECOPD患者疾病严重程度的相关性,并对其预后的预测价值进行探讨。方法选取我院2015年10月-2017年3月收治的96例老年慢性阻塞性肺疾病急性加重期患者作为研究对象,根据病情严重程度将患者分为A组、B组和C组,观察和比较各组患者的凝血功能指标、血气分析指标以及肺功能,并对三种指标间的相关性进行分析。结果三组患者FBG、D-D水平差异具有统计学意义(P<0.05),其中C组FBG、D-D水平相比A组、B组明显增高(P<0.05),B组D-D水平明显高于A组(P<0.05);三组患者在Pa O_2、Pa CO_2以及FEV1%pred水平上差异具有统计学意义(P<0.05);其中与A组、B组比较,C组Pa O_2、FEV1%pred水平明显下降,Pa CO_2水平明显升高(P<0.05);与A组比较,B组Pa O_2、FEV1%pred水平明显下降,Pa CO_2水平明显升高(P<0.05);FBG和D-D均分别与Pa O_2、FEV1%pred呈负相关,而与Pa CO_2呈正相关(P<0.05)。结论并发呼吸衰竭及MODS的老年AECOPD患者血液的高凝状态相比AECOPD患者更加严重,而凝血功能水平与患者的肺功能、酸碱平衡以及缺氧状态密切相关,因此监测AECOPD患者的凝血功能对于尽早采取相关防治措施有着积极的作用。

Objective To observe the correlation between the change of blood coagulation function and the severity of AECOPD in elderly patients,and to evaluate its prognostic value. Methods 96 elderly patients with AECOPD from October 2015 to March 2017 were selected as the research objects,and they were divided into the group A,B and C according to the disease severity. Their blood coagulation function index,blood gas analysis index and pulmonary function were observed in the three groups,and the correlation among the three kinds of indexes was analyzed. Results The levels of FBG and D-D in the three groups had statistical significance（ P〈0. 05）,and they were significantly higher in the group C than in the group A and B（ P〈0. 05）. The level of D-D in the group B was significantly higher than that in the group A（ P〈0. 05）. There were significant differences in the levels of Pa O_2,Pa CO_2 and FEV1% pred among the three groups（ P〈0. 05）. Compared with the group A and B,the levels of Pa O_2 and FEV1% pred was significantly lower,and the level of Pa CO_2 was significantly higher in the group C（ P〈0. 05）.Compared with the group A,the levels of Pa O_2 and FEV1% pred were significantly lower,and the level of Pa CO_2 was significantly higher in the group B（ P〈0. 05）. FBG and D-D were respectively negatively correlated with Pa O_2,and positively correlated with FEV1% pred（ P〈0. 05）. Conclusion The blood high condensation state of elderly patients with AECOPD complicated with respiratory failure and MODS are more serious than those patients only with AECOPD,and the level of blood coagulation function is closely related to lung function,aci D-base balance and anoxic state of patients. Therefore,the monitoring of blood coagulation function in patients with AECOPD has a positive effect to take relevant measures as soon as possible.